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Primary liver sarcomas: Systematic review
Electronic Poster Abstracts Introduction: Cholangiocarcinoma is a tumor with poor prognosis, often unresectable at the time of diagnosis. Surgical treatment is the best chance for cure, however it is challenging and sometimes with border not free from disease, especially for Type IV. New neoadjuvant therapy may improve the survival of patients with potentially resectable cholangiocarcinoma. We present the results of patients with cholangiocarcinoma Type IV that underwent neoadyuvant chemoradiation treatment prior to surgery. Methods: From July 2008 until April 2012, 8 patients have been included. Preoperative work up consists of abdominal ultrasonography, CT and PET scan, RMN and percutaneous trans-hepatic drainage. Portal embolization was performed in 3 patients. Neoadjuvant treatment consist in combination of stereotactic tumor radiotherapy (to a target introduced before) and oral capecitabine. Results: No toxicity was found. Surgical treatment was extended right (2) and left (5) and central hepatectomy (1) with extended lymphadenectomy. Portal vein resection was required in 3 cases. Specimen finally exam was well (5), moderate (2) and poorly (1) differentiated adenocarcinoma, all of them free of disease (R0). Tumor regression rate (TRR) (Rodell) was: TRR 3 (5 patients), TRR 4 (1 patient) and TRR 2 (2 patients). Mortality before 90 days after surgery occurred in 4 patients. Survival rate was 24, 30 (2 patients) and 34 months in the remaining cases. Conclusions: Neoadjuvant chemoradiation for cholangiocarcinoma Type IV may control cancer progression (high TRR), thereby improving oncological surgical resection (all patients had R0 resection) in this study. However post-operative mortality still has an important impact on survival.
EP01B-051 SURGICAL TREATMENT OF GIANT LIVER HEMANGIOMAS LARGER THAN 5CM: A SINGLE CENTER’S EXPERIENCE WITH 25 PATIENTS D. Varun, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran and M. Brahmeswara Rao Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences, India Introduction: Hemangioma is the most common benign tumor of liver. Usually they are asymptomatic but can present with pain abdomen and rarely with complications. Diagnosis is based on imaging. Surgery is indicated for symptomatic patients. Aim: To study the demographic data, mode of presentation, imaging characteristics, surgery done, and outcomes in patients operated for hemangioma in our institute. Methods: All patients operated for hemangioma of liver at our institute from 2000 to 2015 were assessed retrospectively. Demographic data were noted. Imaging findings including the size were noted. Surgery done and postoperative outcomes were recorded. Results: 25 patients underwent surgery for hemangioma of liver during the study period. Mean age was 45.4yrs. 18 were female patients. 21 patients had pain abdomen as symptom, 8 patients complained of lump abdomen. Hemangiomas involved right lobe in 9 patients;left lobe in 10 patients the other 6 patients had multiple hemangiomas. Mean size was 8.35cm. 7 patients underwent enucleation. Right
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hepatectomy (6/25), Left hepatectomy (4/25), Left lateral segmentectomy (4/25) were done as appropriate. Central hepatectomy, right extended hepatectomy, segment 5 resection, left extended hepatectomy were done in 1 patient each. Average operating time was 235 minutes. Post operatively, 2 patients had bile leak. All patients were discharged uneventfully with an average post op stay of 6 days. Conclusion: Liver hemangioma is a commonly found benign tumor of the liver. It is more common in women. Surgery is indicated in symptomatic patients. Surgery, including anatomic resections and enucleation can be safely done for hemangiomas of liver.
EP01B-052 MAJOR LIVER RESECTION FOR HEPATOBLASTOMA, COMPLICATIONS AND OUTCOME H. Soliman1, A. Elgendi2, O. Hegazy3, H. Shoreim3, S. Saleh3, A. Aziz3, I. Marwan3 and K. Abelella3 1 HPB Surgery, Menoufia University, National Liver Institute, 2Surgery, Alexandria University, and 3HPB Surgery, National Liver Institute, Menofyia University, Egypt Hepatoblastoma is the commonest pediatric liver tumors. Surgery is indicated in selected cases. We reviewed our records to evaluate the results of surgical management of these patients. Patients and methods: 37 patients were diagnosed to have hepatoblastoma in the department of Surgery NLI, Menoufia University and The department of Surgery < Alexandria University. We reviewed the preoperative, operative data, postoperative courses and follow up. Results: All the patients had tumours involving more than 3 segments of the rliver. Surgery was performed after a preoperative chemotherapy. Operations included 10 Rt. hepatectomy, 5 Lt. hepatectomy, 5 extended Rt. hepatectomy, 2 Extended Lt. hepatectomy, 3 central hepatectomies, 7 Lt. lateral segmentectomy, 5 non anatomical resections. Complications included major bleeding in 3 cases, bile leak in 3 cases, burst abdomen in 2 cases, 5 wound infections. 3 patients died in due to bleeding and bile leak. Recurrence occurred in 3 cases. Conclusion: The outcome of liver resection is feasible in these cases with acceptable results.
EP01B-053 PRIMARY LIVER SARCOMAS: SYSTEMATIC REVIEW A. Cavalcanti de A Martins, J. Dourado Matos e Silva, D. Cabral da Costa Neto and Y. Moraes Surgery, Instituto de Medicina Integral Prof Fernando Figueira, Brazil Primary liver sarcomas are a rare type of tumor witch is more common in children. In the adult population, it can be presented as a spectrum of various neoplasms with a reserved prognosis. Besides, there is no consensus of the best therapeutic to be used in the treatment of those lesions. Therefore, this
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Electronic Poster Abstracts
Systematic Review was performed to find the best treatment options (surgery and/or chemotherapy and/or radiotherapy) and to determinate prognostic factors and overall survival (OS). Systematic review of articles published on PUBMED and MEDLINE (1966 to april/1/2015), with keywords: Primary liver sarcoma and Primary hepatic sarcoma. Adult patients (>18 years), articles in English, Portuguese and Spanish were included. Case reports, tumors of double origin (carcinosarcomas), metastastatic sarcomas and multiple diagnosis were excluded. Three authors researched individually and the senior author judged the inclusion of the pre-selected articles. After the research, 1273 articles were found, of those 1165 were excluded because they were clearly out of inclusion criteria. In the end were left 108 articles and, after reading all the abstracts, 11 were included. The most common histologic types were leiomyosarcoma, angiosarcoma and epithelioid hemangioendothelioma. Histologic type, differentiation degree and R0 resection were the most influent prognostic factors. The 5 year OS varied from 18% to 65%. Surgery (resection) is the main treatment of primary liver sarcomas. More effective systemic treatments need to be developed to improve the prognosis of this heterogeneous type of tumor.
EP01B-054 EPIDEMIOLOGY OF METASTATIC HEPATOCELLULAR CARCINOMA IN A RAPIDLY GROWING COMMUNITY A. Vijay1, K. Ahmed2, Y. Kamel3, H. Khalaf2, A. Elaffandy2, W. El Ansari1 and W. Elmoghazy2 1 Surgery, 2Surgery/Organ Transplant, and 3Gastroenterology and Hepatology, Hamad Medical Corporation, Qatar Introduction: Our community has grown rapidly over the last 4 years with increasing number of hepatocellular carcinoma (HCC) cases. The purpose of this study is to investigate characteristics of HCC patients and to identify predictors of metastatic tumors. Methods: It includes patients diagnosed with HCC between 2011 and 2015 in Qatar, other primary and secondary liver tumors were excluded. Data including patient and tumor characteristics, clinical and laboratory investigations were collected from medical records. Univariate analysis was done to identify potential predictors of metastatic HCC using Chi-square test and t-test. Multivariate logistic regression analysis was done to assess independent predictors of metastatic HCC. P-value of < 0.05 was considered significant. Results: A total of 180 patients were diagnosed with HCC, 47 of them (26%) developed metastases. There were 150 male patients, and mean age at time diagnosis was 58.8 10.5 years. Follow-up ranged from 0.1 to 4.3 years with a mean of 1.0 1.1 years. Single site metastasis was diagnosed in 10 patients while 37 patients had multiple sites metastases. Metastases included abdominal sites in 24 patients, thoracic in 13, bone in 7 and unusual sites in 3 patients. Potential predictors of metastatic HCC were multi-focal HCC, bilobar lesions, macro-vascular invasion, and tumor diameter >5cm.
Multivariate regression analysis showed that tumor diameter >5cm is independent predictor of metastatic HCC (OR = 3.411, 95% CI = 1.607e7.242) (P = 0.001). In conclusion, metastatic HCC is not rare, it represents 26% of our cohort and tumor >5 cm is associated with high risk of metastasis.
EP01B-055 LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA O. Abbasoglu, E. Hamaloglu and O. Cennet Hacettepe University, Turkey Aim: Hepotocellular carcinoma (HCC) is the most common primary liver cancer. The aim of this study was to analyze our data on liver resection in 99 patients. Method: Between January 2000 and December 2014, 99 patients were operated on for HCC, at Hacettepe University (Ankara, Turkey). The hospital chats wre retrospectively analyzed. The median age of the patients was 66 (range: 17e82) and female to male ratio was 1/3. Viral hepatitis seropositivity was seen in 72 (73%) patients (HbsAg+ in 49 patients, HCV+ in 23 patients). Alfafetoprotein (AFP) level was above the normal limit in 70% of the cases. Tumor was localized in the right lobe in 62 patients and HCC was multinodular 15. Results: During operation 8 patients were found to be inoperable because of peritoneal carcinomatosis or diffuse disease. Of the patients, 45 underwent non-anatomical resection and 41 underwent anatomical resections (including 18 right hepatectomy, 10 left hepatectomy). In 12 patients radiofrequency ablation was combined with surgical resection. The median tumor size was 5.2 cm (range 1e15 cm), median lenght of hospital stay was 6 days (range: 3e61 days). Major complications including bile leaks and hemorrhage were seen in 14% and 30 day mortality rate was 5.2%. Five year actuarial survival rate was found to be 33%. Conclusion: Compared to series from other countries, the median tumor size of our patients was larger and HBsAg positivity and multinodular HCC patients were more common in the resection group. Despite characteristics, acceptable 5 year survival rate can be achieved.
EP01B-056 RARE TUMORS OF LIVER e EXPERIENCE OF TERTIARY CARE CENTRE S. Subramani, R. Vellaisamy, A. Anbalagan, B. Duraisamy, P. Raju, C. Servarayan Murugeasan and K. Devy Gounder Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Govt General Hospital, India Aim: The aim of this study is to analyze the clinical presentation, surgical management, outcome of uncommon liver tumors in a tertiary care center. Methods: This is a retrospective study design between January 2013 to August 2015. The study includes 17 patients. Male 11, female 6. The age group ranged between 13e74 years. The study excluded common indications like Primary hepatocellular carcinoma and Colorectal liver
HPB 2016, 18 (S1), e1ee384
EP01B-051 SURGICAL TREATMENT OF GIANT LIVER HEMANGIOMAS LARGER THAN 5CM: A SINGLE CENTER’S EXPERIENCE WITH 25 PATIENTS D. Varun, V. Venkatarami Reddy, G. Sivaramakrishna, C. Chandramaliteeswaran and M. Brahmeswara Rao Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences, India Introduction: Hemangioma is the most common benign tumor of liver. Usually they are asymptomatic but can present with pain abdomen and rarely with complications. Diagnosis is based on imaging. Surgery is indicated for symptomatic patients. Aim: To study the demographic data, mode of presentation, imaging characteristics, surgery done, and outcomes in patients operated for hemangioma in our institute. Methods: All patients operated for hemangioma of liver at our institute from 2000 to 2015 were assessed retrospectively. Demographic data were noted. Imaging findings including the size were noted. Surgery done and postoperative outcomes were recorded. Results: 25 patients underwent surgery for hemangioma of liver during the study period. Mean age was 45.4yrs. 18 were female patients. 21 patients had pain abdomen as symptom, 8 patients complained of lump abdomen. Hemangiomas involved right lobe in 9 patients;left lobe in 10 patients the other 6 patients had multiple hemangiomas. Mean size was 8.35cm. 7 patients underwent enucleation. Right
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hepatectomy (6/25), Left hepatectomy (4/25), Left lateral segmentectomy (4/25) were done as appropriate. Central hepatectomy, right extended hepatectomy, segment 5 resection, left extended hepatectomy were done in 1 patient each. Average operating time was 235 minutes. Post operatively, 2 patients had bile leak. All patients were discharged uneventfully with an average post op stay of 6 days. Conclusion: Liver hemangioma is a commonly found benign tumor of the liver. It is more common in women. Surgery is indicated in symptomatic patients. Surgery, including anatomic resections and enucleation can be safely done for hemangiomas of liver.
EP01B-052 MAJOR LIVER RESECTION FOR HEPATOBLASTOMA, COMPLICATIONS AND OUTCOME H. Soliman1, A. Elgendi2, O. Hegazy3, H. Shoreim3, S. Saleh3, A. Aziz3, I. Marwan3 and K. Abelella3 1 HPB Surgery, Menoufia University, National Liver Institute, 2Surgery, Alexandria University, and 3HPB Surgery, National Liver Institute, Menofyia University, Egypt Hepatoblastoma is the commonest pediatric liver tumors. Surgery is indicated in selected cases. We reviewed our records to evaluate the results of surgical management of these patients. Patients and methods: 37 patients were diagnosed to have hepatoblastoma in the department of Surgery NLI, Menoufia University and The department of Surgery < Alexandria University. We reviewed the preoperative, operative data, postoperative courses and follow up. Results: All the patients had tumours involving more than 3 segments of the rliver. Surgery was performed after a preoperative chemotherapy. Operations included 10 Rt. hepatectomy, 5 Lt. hepatectomy, 5 extended Rt. hepatectomy, 2 Extended Lt. hepatectomy, 3 central hepatectomies, 7 Lt. lateral segmentectomy, 5 non anatomical resections. Complications included major bleeding in 3 cases, bile leak in 3 cases, burst abdomen in 2 cases, 5 wound infections. 3 patients died in due to bleeding and bile leak. Recurrence occurred in 3 cases. Conclusion: The outcome of liver resection is feasible in these cases with acceptable results.
EP01B-053 PRIMARY LIVER SARCOMAS: SYSTEMATIC REVIEW A. Cavalcanti de A Martins, J. Dourado Matos e Silva, D. Cabral da Costa Neto and Y. Moraes Surgery, Instituto de Medicina Integral Prof Fernando Figueira, Brazil Primary liver sarcomas are a rare type of tumor witch is more common in children. In the adult population, it can be presented as a spectrum of various neoplasms with a reserved prognosis. Besides, there is no consensus of the best therapeutic to be used in the treatment of those lesions. Therefore, this
e210
Electronic Poster Abstracts
Systematic Review was performed to find the best treatment options (surgery and/or chemotherapy and/or radiotherapy) and to determinate prognostic factors and overall survival (OS). Systematic review of articles published on PUBMED and MEDLINE (1966 to april/1/2015), with keywords: Primary liver sarcoma and Primary hepatic sarcoma. Adult patients (>18 years), articles in English, Portuguese and Spanish were included. Case reports, tumors of double origin (carcinosarcomas), metastastatic sarcomas and multiple diagnosis were excluded. Three authors researched individually and the senior author judged the inclusion of the pre-selected articles. After the research, 1273 articles were found, of those 1165 were excluded because they were clearly out of inclusion criteria. In the end were left 108 articles and, after reading all the abstracts, 11 were included. The most common histologic types were leiomyosarcoma, angiosarcoma and epithelioid hemangioendothelioma. Histologic type, differentiation degree and R0 resection were the most influent prognostic factors. The 5 year OS varied from 18% to 65%. Surgery (resection) is the main treatment of primary liver sarcomas. More effective systemic treatments need to be developed to improve the prognosis of this heterogeneous type of tumor.
EP01B-054 EPIDEMIOLOGY OF METASTATIC HEPATOCELLULAR CARCINOMA IN A RAPIDLY GROWING COMMUNITY A. Vijay1, K. Ahmed2, Y. Kamel3, H. Khalaf2, A. Elaffandy2, W. El Ansari1 and W. Elmoghazy2 1 Surgery, 2Surgery/Organ Transplant, and 3Gastroenterology and Hepatology, Hamad Medical Corporation, Qatar Introduction: Our community has grown rapidly over the last 4 years with increasing number of hepatocellular carcinoma (HCC) cases. The purpose of this study is to investigate characteristics of HCC patients and to identify predictors of metastatic tumors. Methods: It includes patients diagnosed with HCC between 2011 and 2015 in Qatar, other primary and secondary liver tumors were excluded. Data including patient and tumor characteristics, clinical and laboratory investigations were collected from medical records. Univariate analysis was done to identify potential predictors of metastatic HCC using Chi-square test and t-test. Multivariate logistic regression analysis was done to assess independent predictors of metastatic HCC. P-value of < 0.05 was considered significant. Results: A total of 180 patients were diagnosed with HCC, 47 of them (26%) developed metastases. There were 150 male patients, and mean age at time diagnosis was 58.8 10.5 years. Follow-up ranged from 0.1 to 4.3 years with a mean of 1.0 1.1 years. Single site metastasis was diagnosed in 10 patients while 37 patients had multiple sites metastases. Metastases included abdominal sites in 24 patients, thoracic in 13, bone in 7 and unusual sites in 3 patients. Potential predictors of metastatic HCC were multi-focal HCC, bilobar lesions, macro-vascular invasion, and tumor diameter >5cm.
Multivariate regression analysis showed that tumor diameter >5cm is independent predictor of metastatic HCC (OR = 3.411, 95% CI = 1.607e7.242) (P = 0.001). In conclusion, metastatic HCC is not rare, it represents 26% of our cohort and tumor >5 cm is associated with high risk of metastasis.
EP01B-055 LIVER RESECTION FOR HEPATOCELLULAR CARCINOMA O. Abbasoglu, E. Hamaloglu and O. Cennet Hacettepe University, Turkey Aim: Hepotocellular carcinoma (HCC) is the most common primary liver cancer. The aim of this study was to analyze our data on liver resection in 99 patients. Method: Between January 2000 and December 2014, 99 patients were operated on for HCC, at Hacettepe University (Ankara, Turkey). The hospital chats wre retrospectively analyzed. The median age of the patients was 66 (range: 17e82) and female to male ratio was 1/3. Viral hepatitis seropositivity was seen in 72 (73%) patients (HbsAg+ in 49 patients, HCV+ in 23 patients). Alfafetoprotein (AFP) level was above the normal limit in 70% of the cases. Tumor was localized in the right lobe in 62 patients and HCC was multinodular 15. Results: During operation 8 patients were found to be inoperable because of peritoneal carcinomatosis or diffuse disease. Of the patients, 45 underwent non-anatomical resection and 41 underwent anatomical resections (including 18 right hepatectomy, 10 left hepatectomy). In 12 patients radiofrequency ablation was combined with surgical resection. The median tumor size was 5.2 cm (range 1e15 cm), median lenght of hospital stay was 6 days (range: 3e61 days). Major complications including bile leaks and hemorrhage were seen in 14% and 30 day mortality rate was 5.2%. Five year actuarial survival rate was found to be 33%. Conclusion: Compared to series from other countries, the median tumor size of our patients was larger and HBsAg positivity and multinodular HCC patients were more common in the resection group. Despite characteristics, acceptable 5 year survival rate can be achieved.
EP01B-056 RARE TUMORS OF LIVER e EXPERIENCE OF TERTIARY CARE CENTRE S. Subramani, R. Vellaisamy, A. Anbalagan, B. Duraisamy, P. Raju, C. Servarayan Murugeasan and K. Devy Gounder Institute of Surgical Gastroenterology, Madras Medical College and Rajiv Gandhi Govt General Hospital, India Aim: The aim of this study is to analyze the clinical presentation, surgical management, outcome of uncommon liver tumors in a tertiary care center. Methods: This is a retrospective study design between January 2013 to August 2015. The study includes 17 patients. Male 11, female 6. The age group ranged between 13e74 years. The study excluded common indications like Primary hepatocellular carcinoma and Colorectal liver
HPB 2016, 18 (S1), e1ee384